Conduct disorder: What you need to know
The condition affects children and adolescents.
Along with oppositional defiant disorder (ODD), conduct disorder is considered a disruptive behavior disorder and it is one of the most common mental health disorders diagnosed in young people.
Young people with this condition can be cruel and violent towards others, including pets and other animals. They may be destructive, breaking and damaging property.
The behavior associated with conduct disorder is not limited to occasional outbursts. It is consistent and repetitive, occurring frequently enough that it interferes with the child's education, family life, and social life.
- Conduct disorder can develop before age 10, or during teen years, and is more common in boys than girls.
- One out of four children diagnosed with attention deficit hyperactivity disorder (ADHD) is at risk of developing conduct disorder.
- Up to 45 percent of teenagers with ADHD display conduct disorder behaviors.
- A child or adolescent with the condition requires proper diagnosis and medical treatment.
Young people with conduct disorder can be cruel and aggressive towards others.
One of the key characteristics of conduct disorder is frequently aggressive, antisocial behavior that goes beyond what is common for a child or adolescent of that age.
A person with conduct disorder may also be driven by a need to dominate other people through acts of aggression or intimidation.
An individual with conduct disorder may appear to disregard the accepted standards of behavior, as well as the feelings of others.
Emotional symptoms of conduct disorder include:
- Lack of remorse: This may appear as an inability to feel guilty about doing something wrong, a failure to feel bad about hurting someone, or indifference to punishment for breaking the rules.
- Lack of empathy: They may disregard the feelings of others and appear cold, callous, or uncaring.
- Disregards expectations: The individual may not care about performing well in school or other activities. They may seem to ignore others' expectations of them, even if they are given clear tasks.
- Lack of emotional expression: The individual may not display any emotions. They may appear shallow or superficial or may seem to be able to turn emotions "on and off" at will. When they do show emotion, they may use their emotional response to manipulate others.
Behaviors or actions an individual with conduct disorder may display include:
- breaking rules at home and school
- getting into fights
- breaking & entering
- lying or being deceitful
- manipulating others
- skipping school
- running away from home
- cruelty to animals
When young children develop conduct disorder, the first signs are often biting and hitting.
In older children and teenagers, symptoms may develop into lying, stealing, fighting (sometimes with weapons), property damage, and sexual coercion.
Individuals with conduct disorder may have difficulty reading social cues, which can lead to further aggression.
They may be more likely to assume that someone else's behavior is more hostile than it is. When they respond to this perceived hostility, they may add tension to a situation and create conflict.
Conduct disorder frequently co-exists with other conditions, including:
Family therapy has proved effective for conduct disorder.
A young person with conduct disorder may be perceived as a juvenile delinquent, rather than an individual with a mental health condition. Treating conduct disorder solely as a discipline problem is rarely effective.
The key to effective treatment of conduct disorder is early intervention. Doctors and caregivers should also be sure to address all the aspects of an individual's life that are affected by the problematic behavior, including home, school, social situations, and the community.
Family therapy, multi-systemic therapy, and cognitive behavioral treatment (CBT) have been found to be an effective treatment for conduct disorder.
Multi-systemic therapy is a comprehensive approach, meaning that the child or teenager receives treatment in multiple situations, including their home and school.
Parent training can help family members develop effective tools for dealing with conduct disorder by showing them how to establish clear limits, encourage positive actions, and discourage disruptive behavior.
Research has documented the long-term effectiveness of parent training techniques.
As conduct disorder often develops at the same time as other conditions, such as ADHD, treatment will be more effective if it addresses all the health issues a person is facing.
There is no direct cause of conduct disorder, but researchers think it is influenced by both genetics and environmental factors.
Children have an increased risk of developing conduct disorder if one of their parents or a sibling has it. Research also suggests that there may be a genetic link for an increased risk of conduct disorder and ADHD.
Children who have suffered abuse, parental rejection, or neglect may also be more likely to develop conduct disorder.
Living in a low-income or disadvantaged area can also increase a child's risk of developing conduct disorder. Some researchers theorize that this is due to the effects of economic, social, and emotional instability.
The researchers state that disadvantaged parents or caregivers may lack the skills needed to intervene in problematic behaviors or early signs of conduct disorder. They recommend establishing parent training programs as a preventative measure.
Research suggests that children or adolescents that experience ADHD, as well as conduct disorder, may have neurological conditions that make it difficult for them to express themselves in words or exercise self-control.
A quarter of those diagnosed with ADHD are at risk of developing conduct disorder.
Only a mental health professional with expertise in children's mental health can make a diagnosis of conduct disorder.
The steps involved in diagnosis include:
- taking a complete social and medical history of the child and the family
- interviewing and observing the child
- interviewing the family
- doing standardized tests
- examining the socio-economic context of the child's behavior
It is important to note that almost all children will, at some point in their lives, behave in ways that are disruptive and even dangerous.
As children come to understand the effects of their behavior at school and in the family, they will all experience episodes of disruptive behavior. These temporary episodes are normal during a person's development.
However, symptoms of a mental health condition, such as conduct disorder, are persistent, consistent, frequent, and repetitive.
If conduct disorder persists into adulthood, it can become increasingly problematic.
Adults who have conduct disorder may have difficulty holding down a job or maintaining relationships and may become prone to illegal or dangerous behavior.
Symptoms of conduct disorder in an adult may be diagnosed as adult antisocial personality disorder.
According to Mental Health America, many young people with conduct disorder grow up to enjoy fulfilling social and work lives. The earlier treatment starts, the better the outlook will be.
Research suggests that when people develop conduct disorder as young children, instead of as teens, they are more likely to exhibit criminal behavior as adults. This is not always the case but is something for parents and caregivers to be mindful of and discuss with a doctor.
According to Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), children diagnosed with both ADHD and conduct disorder are "twice as likely to have difficulty reading, and are at greater risk for social and emotional problems."
The long-term outlook improves when parents or caregivers take part in a behavior-based parent-training program.
According to one study, 63 percent of children whose parents participated in such a program showed a small improvement in their behavior, 54 percent showed a large improvement, and 39 percent showed a very large improvement.